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VBS Student Registration - July 9-12 - 6-8:30PM (Ages 5-10)
VBS Student Registration - July 9-12 - 6-8:30PM (Ages 5-10)
Custodial Parent / Guardian Information
*
Indicates required field
Parent's Name
*
First
Last
Phone Number
*
Email
*
Choose One
*
I will be dropping off my child/children
I will be picking up my child/children
Parent's Name
*
First
Last
[object Object]
Phone Number
*
Email
*
Other Person's Name, responsible for picking up and dropping off your child/children during VBS if different from custodial parent.
*
First
Last
Phone Number
*
Relationship to child:
*
Email
*
Student Information
Child # 1 - Name
*
First
Last
Gender:
*
Male
Female
Date of Birth:
*
Age:
*
Grade Entering:
*
Child's Address
*
Line 1
Line 2
City
State
Zip Code
Country
Name of Church child attends regularly
*
Please list any allergies, medical conditions, and/or physical limitations that we need to be aware of:
*
List any special talents, gifts, interests, hobbies for your child:
*
Child #2 Name
*
First
Last
[object Object]
Gender:
*
Male
Female
Date of Birth
*
Age:
*
Grade Entering:
*
Child #2 Address
*
Line 1
Line 2
City
State
Zip Code
Country
Name of church child attends regularly:
*
Please list any allergies, medical conditions, and/or physical limitations that we need to be aware of:
*
List any special talents, gifts, interests, hobbies for your child:
*
Submit